Provider Demographics
NPI:1659889202
Name:HASAN, MARIA A (LPN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:HASAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9510 N 82ND LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-3120
Mailing Address - Country:US
Mailing Address - Phone:623-330-9504
Mailing Address - Fax:
Practice Address - Street 1:8687 E VIA DE VENTURA
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-3347
Practice Address - Country:US
Practice Address - Phone:480-609-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ053988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ053988OtherLPN